中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (12): 1853-1858.doi: 10.3969/j.issn.2095-4344.1123

• 数字化骨科 digital orthopedics • 上一篇    下一篇

3D打印点接触导板在胸腰段骨质疏松性椎体压缩骨折经皮椎体成形治疗中的应用

张佳园，周 全，赵加力，张 明，方 涛，王新宏，潘 伟   

  1. 徐州医科大学附属淮安医院骨科，江苏省淮安市 223002
  • 出版日期:2019-04-28 发布日期:2019-04-28
  • 通讯作者: 周全，博士，主任医师。徐州医科大学附属淮安医院骨科，江苏省淮安市 223002
  • 作者简介:张佳园，男，1990年生，徐州医科大学在读医学硕士，江苏省人，汉族，医师，主要从事3D打印导板辅助椎弓根精确置钉方面的研究。
  • 基金资助:

    淮安市科技计划项目(HAP201608)，项目负责人：周全；江苏省科技项目(BK20171265)，项目负责人：周全

Application of three-dimensional printing point-contact guide template in percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures  

Zhang Jiayuan, Zhou Quan, Zhao Jiali, Zhang Ming, Fang Tao, Wang Xinhong, Pan Wei   

  1. Department of Orthopedics, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223002, Jiangsu Province, China
  • Online:2019-04-28 Published:2019-04-28
  • Contact: Zhou Quan, MD, Chief physician, Department of Orthopedics, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223002, Jiangsu Province, China
  • About author:Zhang Jiayuan, Master candidate, Physician, Department of Orthopedics, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223002, Jiangsu Province, China
  • Supported by:

    the Science and Technology Program of Huai’an, No. HAP201608 (to ZQ); the Science and Technology Project of Jiangsu Province, No. BK20171265 (to ZQ)

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摘要：

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文题释义：
3D打印点接触导板：试验利用3个不在一条直线上的点确定一个平面的原理，设计出一种3D打印点接触导板，利用3D打印点接触导板与皮肤进行3点接触，以期避免“面接触导板”与皮肤不能完全接触吻合对穿刺定位定向的干扰，用于辅助经皮椎体成形术中椎弓根穿刺定位。
经皮椎体成形术：是指经皮通过椎弓根或椎弓根外向椎体内注入骨水泥以达到增加椎体强度和稳定性，防止塌陷，缓解疼痛，甚至部分恢复椎体高度为目的一种微创脊椎外科技术。因其具有创伤小、疼痛缓解率高、起效快等优点，已成为目前治疗骨质疏松性椎体压缩骨折、椎体转移瘤、血管瘤、骨髓瘤等疾病的主要微创方法。
 
摘要
背景：有些学者利用3D打印技术设计制作经皮导板辅助椎弓根穿刺，减少了经皮椎体(后凸)成形中透视次数及手术时间，增加了手术安全性。但此类导板均为“面接触导板”，应用时需导板与皮肤完全贴合，患者体位变化常导致导板与皮肤不容易完全贴合，需要多次调整甚至失去导引作用。而用于经皮椎弓根定位的3D打印点接触导板研究较少。
目的：探讨3D打印点接触导板应用于经皮椎体成形术治疗胸腰段骨质疏松性椎体压缩骨折的临床效果。
方法：2017年1月至2018年4月共纳入徐州医科大学附属淮安医院40例单节段骨质疏松性椎体压缩骨折拟行经皮椎体成形术患者，将其随机分成2组，对照组20例行传统经皮椎体成形术，试验组20例行3D打印点接触导板辅助下的经皮椎体成形术。记录每次手术穿刺针到达理想穿刺位置前的透视次数以及时间、术中透视总次数、手术时间、术前及术后1 d疼痛目测类比评分等指标。
结果与结论：两组患者均顺利完成手术。试验组术中获得理想穿刺位置前的透视次数以及时间、术中透视总次数、手术时间均显著少于对照组(P < 0.05)；两组患者术后疼痛目测类比评分均较术前明显降低(P < 0.05)。结果证实，3D打印点接触导板辅助胸腰段骨质疏松性椎体压缩骨折经皮椎体成形术，有利于穿刺针精准置入，减少穿刺过程的透视次数，缩短手术时间。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-9619-2187(周全)

关键词: 椎体成形术, 3D打印点接触导板, 穿刺定位, 胸腰段, 椎体压缩骨折, 经皮导板, 术中透视, 理想穿刺位置, 导向, 吻合

Abstract:

BACKGROUND: Some scholars used three-dimensional printing technology to design and manufacture percutaneous guide templates to assist pedicle puncture, which reduces the times of fluoroscopy and operation time and increases the safety in percutaneous vertebroplasty (kyphosis). However, such guide templates are all “surface-contact guide templates”, and the guide templates need to be completely adhere to the skin during application. The change of the patient’s body position often causes the guide templates and the skin to not completely fit, and needs to be adjusted so many times or even loses the purpose of guiding. There were few studies on three-dimensional printing point-contact guide templates for percutaneous pedicle positioning.

OBJECTIVE: To explore the clinical effect of three-dimensional printing point-contact guide template in the treatment of thoracolumbar osteoporotic vertebral compression fractures with percutaneous vertebroplasty.
METHODS: Forty patients with single-segment osteoporotic vertebral compression fractures in Affiliated Huai’an Hospital of Xuzhou Medical University from January 2017 to April 2018 were enrolled, and were randomly divided into control and trial groups (n=20 per group). The control group underwent traditional percutaneous vertebroplasty, and the trial group received percutaneous vertebroplasty with the aid of three-dimensional printing point-contact guide templates. The times of fluoroscopy and the time before the surgical needle reached the ideal puncture position, the total times of intraoperative fluoroscopy, the operation time, and the Visual Analog Scale scores at baseline and 1 day postoperatively were recorded.
RESULTS AND CONCLUSION: Both groups of patients successfully completed the operation. The times of fluoroscopy and the time before the surgical needle reached the ideal puncture position, the total times of intraoperative fluoroscopy, and the operation time in the trial group were significantly lower than those in the control group (P < 0.05). The postoperative Visual Analog Scale scores in both groups were significantly lower than those at baseline (P < 0.05). These results indicate that the three-dimensional printing point-contact guide templates assisting the thoracolumbar osteoporotic vertebral compression fracture with percutaneous vertebroplasty, can facilitate the accurate placement of the needle, reduce the times of fluoroscopy and shorten the operation time.

Key words: Spine, Osteoporosis, Tissue Engineering

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